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(Journal of Nutrition. 2000;130:139-145.)
© 2000 The American Society for Nutritional Sciences


Article

Orally Administered Leucine Stimulates Protein Synthesis in Skeletal Muscle of Postabsorptive Rats in Association with Increased eIF4F Formation1 ,2

Joshua C. Anthony3, Tracy Gautsch Anthony, Scot R. Kimball, Thomas C. Vary and Leonard S. Jefferson4

Department of Cellular and Molecular Physiology, The Pennsylvania State University College of Medicine, Hershey, PA 17033

4To whom correspondence should be addressed.


    ABSTRACT
 TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
We investigated the protein synthetic response of skeletal muscle to an orally administered dose of leucine given alone or in combination with carbohydrate. Male rats were freely fed (F) or food deprived for 18 h; food-deprived rats were then administered saline (S), carbohydrate (CHO), leucine (L) or a combination of carbohydrate plus leucine (CL). CHO and CL meals were isocaloric and provided 15% of daily energy requirements. L and CL meals each delivered 270 mg leucine. Muscle protein synthesis in S was 65% of F (P < 0.01) 1 h after meal administration. Concomitant with lower rates of protein synthesis, phosphorylation of the translational repressor, eukaryotic initiation factor (eIF)4E-binding protein 1 (4E-BP1), was less in S, leading to greater association of 4E-BP1·eIF4E, and reduced formation of the active eIF4G·eIF4E complex compared with F (P < 0.01). Oral administration of leucine (L or CL), but not CHO, restored protein synthesis equal to that in F and resulted in 4E-BP1 phosphorylation that was threefold greater than that of S (P < 0.01). Consequently, formation of 4E-BP1·eIF4E was inhibited and eIF4G·eIF4E was not different from F. The amount of eIF4E in the phosphorylated form was greater in S and CHO (P < 0.01) than in all other groups. In contrast, no differences in the phosphorylation state of eIF2{alpha} or the activity of eIF2B were noted among treatment groups. Serum insulin was elevated 2.6- and 3.7-fold in CHO and CL, respectively, but was not different in L, compared with S (P < 0.05). These results suggest that leucine stimulates protein synthesis in skeletal muscle by enhancing eIF4F formation independently of increases in serum insulin.


KEY WORDS: • leucine • protein synthesis • translation initiation • skeletal muscle • rats


    INTRODUCTION
 TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
Feeding induces a rapid increase in the synthesis rate of total mixed proteins in skeletal muscle of growing postabsorptive animals (Garlick et al. 1973Citation and 1983Citation , Svanberg et al. 1996Citation , Yoshizawa et al. 1998Citation ). The signals responsible for stimulating muscle protein synthesis remain unclear; however, several studies have suggested a role for amino acids in mediating this anabolic response (Gautsch et al. 1998Citation , Preedy and Garlick 1986Citation , Svanberg et al. 1997Citation , Yoshizawa et al. 1995Citation and 1998Citation ). In particular, a number of investigators reported that the branched-chain amino acid, leucine, is unique in its ability to independently stimulate muscle protein synthesis in vitro (Buse and Reid 1975Citation , Hong and Layman 1984Citation , Li and Jefferson 1978Citation ). Further, in a recent study, we reported that oral administration of leucine increases protein synthesis in skeletal muscle of postabsorptive rats after exercise (Anthony et al. 1999Citation ). The mechanism for stimulation of muscle protein synthesis after leucine administration remains to be elucidated; however, studies in vitro (Buse and Reid 1975Citation , Buse et al. 1979Citation , Kimball et al. 1998bCitation ) and in perfused hindlimb preparations (Li and Jefferson 1978Citation ) have suggested that leucine exerts its effects via enhanced rates of mRNA translation.

The initiation of mRNA translation is a complex process requiring several steps and more than a dozen eukaryotic initiation factors (eIF)5 (reviewed by Pain 1996Citation , Voorma et al. 1994Citation ). Two steps in the initiation pathway are subject to regulation in vivo as follows: 1) the binding of initiator methionyl-tRNA (met-tRNAi) to the 40 S ribosomal subunit and 2) the binding of mRNA to the 43 S preinitiation complex. In the first step, met-tRNAi binds to the 40 S ribosomal subunit as a ternary complex with eIF2 and GTP. Subsequently, the GTP bound to eIF2 is hydrolyzed to GDP, and eIF2 is released from the ribosomal subunit as a complex with GDP. For eIF2 to participate in another round of initiation, it must exchange GDP for GTP before formation of a new ternary complex can occur. A second initiation factor, eIF2B, mediates guanine nucleotide exchange on eIF2. Inhibition of eIF2B activity results in a decrease in the amount of eIF2·GTP available to form the ternary complex, thereby restraining translation initiation. eIF2B activity is regulated reciprocally in part by phosphorylation of eIF2. Phosphorylation of the {alpha}-subunit of eIF2 converts eIF2 from a substrate to a competitive inhibitor of eIF2B (Kimball and Jefferson 1994Citation ).

The binding of mRNA to the 43 S preinitiation complex requires a group of proteins collectively referred to as eIF4F. eIF4F is a multisubunit complex consisting of the following: 1) eIF4A, a RNA helicase that functions in conjunction with another protein, eIF4B, to unwind secondary structure in the 5'-untranslated region of the mRNA; 2) eIF4E, a protein that binds the m7GTP cap present at the 5'-end of the mRNA; and 3) eIF4G, a large, 220-kDa polypeptide that functions as a scaffold for eIF4E, eIF4A, the mRNA (via association with eIF4E) and the ribosome (via association with eIF3). Collectively, the eIF4F complex serves to recognize, unfold and guide the mRNA to the 43S preinitiation complex (Pain 1996Citation ).

Formation of an active eIF4F complex is influenced by alterations in either the phosphorylation state or the availability of eIF4E. Phosphorylation of eIF4E is suggested to stimulate translation rates via increased association with eIF4G and eIF4A (Morley et al. 1993Citation ) and/or increased mRNA cap-binding affinity (Minich et al. 1994Citation ). Alternatively, the availability of eIF4E for eIF4F complex formation appears to be regulated by the translational repressor, eIF4E-binding protein 1 (4E-BP1) (Pause et al. 1994Citation ). 4E-BP1 competes with eIF4G for binding eIF4E and is able to sequester eIF4E into an inactive complex. The binding of 4E-BP1 to eIF4E is regulated by phosphorylation of 4E-BP1, with increased phosphorylation of the protein causing a decrease in the affinity of 4E-BP1 for eIF4E.

The objective of this study was to investigate the mechanism by which an oral dose of leucine promotes protein synthesis in skeletal muscle of food-deprived rats.


    MATERIALS AND METHODS
 TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
Animals and experimental design.

The animal facilities and protocol were reviewed and approved by the Institutional Animal Care and Use Committee of the Pennsylvania State University, College of Medicine. Male Sprague-Dawley rats (~200 g) were maintained on a 12-h light:dark cycle with food (Harlan-Teklad Rodent Chow, Madison, WI) and water provided freely. The feed contained ~24% protein and 4% fat.

Rats were either freely fed (F) or food deprived for 18 h. Food-deprived rats were randomly assigned to one of four groups, i.e., not refed, but administered saline (S), or administered a 100% carbohydrate meal (CHO), a 100% leucine meal (L) or a combination of carbohydrate plus leucine (CL). The dose for all experimental meals was 5 mL provided by oral gavage. S rats were fed 5 mL saline (0.155 mol/L). Both freely fed and food-deprived rats were allowed free access to water, but no food was available to the food-deprived rats beyond the defined experimental meals.

The carbohydrate meal provided 2.63 g of carbohydrate and consisted of 262.5 g/L glucose and 262.5 g/L sucrose in distilled water. The leucine meal provided 0.27 g of leucine prepared as 54.0 g/L L-leucine in distilled water. The amount of leucine given was equivalent to the amount of leucine consumed by rats of this age and strain during 24 h of free access to an AIN-93 powdered diet (Harlan-Teklad, Madison, WI) (Gautsch et al. 1998Citation ). The carbohydrate plus leucine meal (235.5 g/L glucose, 235.5 g/L sucrose and 54.0 g/L leucine in distilled water) was isocaloric with the carbohydrate meal and isonitrogenous with the leucine meal. The carbohydrate meal and the carbohydrate plus leucine meal supplied ~15% of daily energy intake for this age and strain of rat (Gautsch et al. 1998Citation ).

A metabolic tracer consisting of a flooding dose (1.0 mL/100 g body weight) of L-[2,3,4,5,6-3H] phenylalanine (150 mmol/L containing 3.70 GBq/L) was injected via the tail vein 50 min after meal administration for the measurement of synthesis of total mixed proteins in skeletal muscle (Garlick et al. 1980Citation ). Exactly 1 h after meal administration, rats were killed by decapitation. Trunk blood was collected and centrifuged at 1800 x g for 10 min to obtain serum. The right gastrocnemius and plantaris were excised as a unit for the measurement of skeletal muscle protein synthesis and quickly frozen in liquid nitrogen. The contralateral muscles were excised similarly and divided into two parts. One portion was weighed, and homogenized in 7 vol of buffer consisting of (mmol/L) 20 N-2-hydroxyethylpiperazine-N'-2-ethanesulfonic acid (pH 7.4), 100 KCl, 0.2 EDTA, 2 ethylene glycol-bis(ß-aminoethyl ether)-N,N,N',N'-tetraacetic acid, 1 dithiothreitol, 50 sodium fluoride, 50 ß-glycerophosphate, 0.1 phenylmethylsulfonyl fluoride, 1 benzamidine and 0.5 sodium vanadate. The homogenate was immediately centrifuged at 10,000 x g for 10 min at 4°C. The supernatant was used for measurement of eIF distribution and phosphorylation as described below. The other portion of hindlimb muscle was used to determine eIF2B activity. All serum and tissue samples were stored at -80°C.

Serum measurements.

Serum insulin concentrations were analyzed using a commercial RIA kit for rat insulin (Linco Research, St. Charles, MO). Serum leucine concentrations were determined using reversed-phase HPLC after precolumn derivatization of amino acids with o-phthaldialdehyde as described previously (Furst et al. 1990Citation ).

Measurement of skeletal muscle protein synthesis.

Fractional rates of skeletal muscle protein synthesis were estimated from the rate of incorporation of radioactive phenylalanine into muscle protein using the specific radioactivity of serum phenylalanine as representative of the precursor pool (Kimball et al. 1992Citation ). The elapsed time from injection of the metabolic tracer until freezing of muscle in liquid nitrogen was recorded as the actual time for incorporation of the radiolabeled amino acid into protein.

Quantitation of phosphorylated and unphosphorylated eIF2{alpha}.

eIF2 was immunoprecipitated from aliquots of 10,000 x g supernatants using an anti-eIF2{alpha} monoclonal antibody. The proportion of eIF2{alpha} present in the phosphorylated form was determined by protein immunoblot analysis after separation of the phosphorylated and unphosphorylated forms of the protein using slab gel isoelectric focusing electrophoresis as described previously (Kimball et al. 1998bCitation ).

Quantitation of 4E-BP1·eIF4E and eIF4G·eIF4E complexes.

eIF4E was immunoprecipitated from 10,000 x g supernatants using a monoclonal antibody to eIF4E (Kimball et al. 1997Citation ). Next, samples were subjected to immunoblot analysis using either a monoclonal antibody to 4E-BP1 or a polyclonal antibody to eIF4G to determine the association of 4E-BP1 and eIF4G with eIF4E, respectively, as described previously (Kimball et al. 1997Citation ). Results were normalized to the amount of eIF4E in the immunoprecipitate.

Quantitation of phosphorylated and unphosphorylated eIF4E.

The phosphorylated and unphosphorylated forms of eIF4E were separated by isoelectric focusing of 10,000 x g supernatants on a slab gel and quantitated by protein immunoblot analysis as described previously (Kimball et al. 1997Citation ).

Examination of 4E-BP1 phosphorylation state.

4E-BP1 was immunoprecipitated from 10,000 x g supernatants of skeletal muscle with an anti-4E-BP1 monoclonal antibody and subjected to protein immunoblot analysis as described previously (Kimball et al. 1997Citation ).

Phosphorylation of p70S6k.

Phosphorylation of the 70-kDa ribosomal protein S6 kinase, p70S6k, was determined in 10,000 x g supernatants by protein immunoblot analysis as previously described (Gautsch et al. 1998Citation ).

Measurement of eIF2B activity.

The guanine nucleotide exchange activity of eIF2B in skeletal muscle was measured by the exchange of [3H]GDP bound to eIF2 for nonradioactively labeled GDP as described previously (Kimball and Jefferson 1988Citation ).

Statistical analysis.

All data were analyzed by the STATISTICA software package for the Macintosh, volume II (StatSoft, Tulsa, OK). Data were analyzed using a one-way ANOVA to assess main effects with treatment group (nutritional status + meal) as the independent variable. Serum leucine was analyzed using a one-way ANOVA after logarithmic transformation of the data. When a significant overall effect was detected, differences among individual means were assessed with Duncan’s Multiple Range post-hoc test. The level of significance was set at P < 0.05 for all statistical tests.


    RESULTS
 TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
Food deprivation reduced serum insulin concentrations (Table 1Citation ) to 23% of the values measured in freely fed rats (S vs. F). Oral administration of carbohydrate (CHO) or a combination of carbohydrate plus leucine (CL) resulted in serum insulin values that were 2.6- and 3.7-fold greater, respectively, than those of food-deprived rats (S). In contrast, administration of leucine alone (L) did not increase serum insulin concentrations relative to rats that were food deprived.


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Table 1. Serum leucine and insulin concentrations, skeletal muscle protein synthesis and skeletal muscle eukaryotic initiation factor (eIF)2B activity in male rats that were freely-fed (F), food-deprived (S), or refed carbohydrate (CHO), leucine (L) or both (CL)123

 
Serum leucine concentrations were not affected by food deprivation (S vs. F; Table 1Citation ). In contrast, administration of carbohydrate (CHO) lowered serum leucine to 46% of the values measured in food-deprived rats (S). Although the amounts of leucine in L and CL were the same, administration of these meals did not result in equivalent serum leucine concentrations. Serum leucine in rats provided leucine alone was 16-fold greater than in S. In contrast, circulating concentrations of leucine in rats administered the carbohydrate plus leucine meal were stimulated 5.5-fold. Provision of carbohydrate may have slowed intestinal absorption of the amino acid, resulting in reduced serum leucine concentrations in CL compared with L. Alternatively, lower serum leucine in CL may be attributed to a higher rate of leucine disposal. Regardless of the basis for the difference in serum leucine concentrations between L and CL, protein synthesis was stimulated equally after administration of either leucine-containing meal (see below).

Protein synthesis (Table 1)Citation was depressed to 65% of values observed in skeletal muscle from rats that had been previously freely fed after 18 h of food deprivation (S vs. F). Provision of carbohydrate alone did not affect muscle protein synthesis. In contrast, administration of either leucine alone or the combination of carbohydrate plus leucine stimulated complete recovery of muscle protein synthesis. In both cases (L and CL), rates of protein synthesis were not different from values in freely fed controls.

To examine potential mechanisms responsible for stimulating protein synthesis by leucine, we first examined the guanine nucleotide exchange activity of eIF2B after meal administration. eIF2B activity was not altered by 18 h of food deprivation or by provision of nutrients (Table 1)Citation . Similarly, there were no differences observed in the phosphorylation state of eIF2{alpha} among the groups (Fig. 1Citation ). Skeletal muscle eIF2{alpha} was almost entirely in the dephosphorylated state irrespective of the treatment group. Therefore, eIF2B activity was not altered by changes in the nutritional status of the rats and cannot explain the stimulatory effect of leucine on muscle protein synthesis.



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Figure 1. Phosphorylation of eukaryotic initiation factor (eIF)2{alpha} in skeletal muscle of male rats that were freely fed (F), food deprived (S) or refed carbohydrate (CHO), leucine (L) or both (CL) measured 1 h after meal administration. In controls, rat liver eIF2{alpha} demonstrated both phosphorylated and unphosphorylated forms of eIF2{alpha} (noted to the right of the immunoblot). Data shown are representative of 8 rats per group.

 
The amount of eIF4E available for eIF4F active complex formation can also limit rates of protein synthesis. Decreases in eIF4E availability occur via 4E-BP1 sequestering eIF4E into an inactive complex, preventing eIF4E from binding eIF4G. On an immunoblot, this is visualized as an increase in the amount of 4E-BP1 present in the eIF4E immunoprecipitate. Accompanying the depression in muscle protein synthesis after 18 h of food deprivation, 4E-BP1·eIF4E complex formation was twofold greater in S compared with F (Fig. 2Citation ). Provision of the carbohydrate meal did not alter the association of 4E-BP1 with eIF4E. In contrast, administration of either carbohydrate plus leucine or leucine alone reduced the amount of 4E-BP1 present in the eIF4E immunoprecipitate, resulting in values that were not different from those of freely fed rats.



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Figure 2. Amount of eukaryotic initiation factor (eIF)4E-binding protein 1 (4E-BP1) associated with eIF4E in skeletal muscle of male rats that were freely fed (F), food deprived (S) or refed carbohydrate (CHO), leucine (L) or both (CL) 1 h after meal administration. (A) A representative immunoblot with positions of {alpha}- and ß-forms of 4E-BP1 noted to the right. (B) Values are means ± SEM; n = 10–12. Means not sharing a superscript are different, P <= 0.05.

 
The only known mechanism for regulating the association of eIF4E and 4E-BP1 involves modulation of the phosphorylation state of 4E-BP1. Hyperphosphorylation of 4E-BP1 results in a decreased affinity of the binding protein for eIF4E. The phosphorylation state of 4E-BP1 can be examined by using SDS-PAGE. During SDS-PAGE, 4E-BP1 is resolved into multiple electrophoretic forms, termed {alpha}, ß and {gamma}, representing the differentially phosphorylated forms of the protein. The most highly phosphorylated form, i.e., the {gamma}-form, exhibits the slowest electrophoretic mobility and does not bind eIF4E. Therefore, in this study, phosphorylation of 4E-BP1 was expressed as the percentage of the protein in the {gamma}-form (Fig. 3Citation ). The total amount of 4E-BP1 did not differ among the groups (data not shown). Food deprivation reduced the amount of 4E-BP1 in the {gamma}-form to 20% of values in freely fed controls. Rats fed carbohydrate alone did not differ in 4E-BP1 phosphorylation compared with food-deprived rats. In contrast, the amount of 4E-BP1 in the {gamma}-form in rats fed leucine (L and CL) was at least threefold greater than in food-deprived rats. These data provide evidence that oral administration of leucine stimulates phosphorylation of 4E-BP1.



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Figure 3. Amount of eukaryotic initiation factor (eIF)4E-binding protein 1 (4E-BP1) in the {gamma}-phosphorylated form as a percentage of the total 4E-BP1 in skeletal muscle of male rats that were freely fed (F), food deprived (S) or refed carbohydrate (CHO), leucine (L) or both (CL) 1 h after meal administration. (A) A representative immunoblot with positions of {alpha}-, ß- and {gamma}-forms of 4E-BP1 noted to the right. (B) Values are means ± SEM; n = 10–12. Means not sharing a superscript are different, P <= 0.05.

 
Consistent with the above data, the amount of eIF4G present in the eIF4E immunoprecipitate was reduced to 30% of values in freely fed controls after food deprivation (Fig. 4Citation ). Administration of carbohydrate alone did not promote the association of eIF4E with eIF4G. In contrast, eIF4G·eIF4E complex formation was twofold greater in rats fed leucine alone compared with S, resulting in values that were not different from those of freely fed controls. Administration of carbohydrate plus leucine also enhanced the association of eIF4E with eIF4G equivalent to an intermediate value that did not differ from all other groups. Collectively, these results suggest that oral administration of leucine increases eIF4E availability for the formation of the active eIF4F complex.



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Figure 4. Amount of eukaryotic initiation factor (eIF)4G associated with eIF4E in skeletal muscle of male rats that were freely fed (F), food deprived (S) or refed carbohydrate (CHO), leucine (L) or both (CL) 1 h after meal administration. (A) A representative immunoblot. (B) Values are means ± SEM; n = 10. Means not sharing a superscript are different, P <= 0.05.

 
To investigate further the mechanism through which eIF4F function is altered, changes in the phosphorylation state of eIF4E were examined. The phosphorylation of eIF4E in vitro has been shown to be increased under a variety of conditions in which translation rates are enhanced (Sonenberg 1996Citation ). In this study, 18 h of food deprivation resulted in a 29% increase in the amount of eIF4E found in the phosphorylated form (Fig. 5Citation ). Administration of carbohydrate alone did not alter the percentage of eIF4E found in the phosphorylated form compared with food-deprived rats. In contrast, provision of carbohydrate plus leucine or leucine alone resulted in a partial dephosphorylation of eIF4E, yielding values that were not different from those in freely fed rats. Therefore, our data indicate that oral administration of leucine promotes the partial dephosphorylation of eIF4E in skeletal muscle.



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Figure 5. Amount of phosphorylated eukaryotic initiation factor (eIF)4E as a percentage of total eIF4E in skeletal muscle of male rats that were freely fed (F), food deprived (S) or refed carbohydrate (CHO), leucine (L) or both (CL) 1 h after meal administration. (A) A representative immunoblot with phosphorylated and unphosphorylated forms of eIF4E noted to the right. (B) Values are means ± SEM; n = 8. Means not sharing a superscript are different, P <= 0.05.

 
Earlier studies using cells in culture suggested that changes in 4E-BP1 phosphorylation modulated by insulin (Kimball et al. 1998aCitation ) or leucine (Kimball et al. 1998bCitation ) occur via one or more pathways that also result in the activation of the 70-kDa ribosomal protein S6 kinase, p70S6k. p70S6k has been implicated in stimulating protein synthesis under conditions that promote 4E-BP1 phosphorylation (Sonenberg 1996Citation ). Phosphorylation of the p70S6k is associated with its activation (Cheatham et al. 1994Citation , Chung et al. 1994Citation ). After SDS-PAGE, p70S6k resolves into multiple electrophoretic forms, with increased phosphorylation corresponding to decreased electrophoretic mobility. Only the most highly phosphorylated forms of the kinase are associated with increased p70S6k activity in vivo (Weng et al. 1998Citation ). Food deprivation resulted in greater electrophoretic mobility, suggesting that p70S6k activation was reduced compared with freely fed controls (Fig. 6Citation ). Provision of carbohydrate alone promoted a slight shift to a more slowly migrating form. Administration of leucine or carbohydrate plus leucine further enhanced phosphorylation of the kinase and resulted in bands with the slowest electrophoretic mobility. These results suggest that leucine activates p70S6k activity in muscle of food-deprived rats independent of increases in serum insulin.



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Figure 6. Phosphorylation of 70-kDa ribosomal protein S6 kinase (p70S6k) in skeletal muscle of male rats that were freely fed (F), food deprived (S) or refed carbohydrate (CHO), leucine (L) or both (CL) measured 1 h after meal administration. Arrows indicate multiple electrophoretic forms of p70S6k. Data shown are representative of 8 rats per group.

 

    DISCUSSION
 TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
Individual amino acids are marketed as nutritional supplements designed to maintain or increase lean tissue mass. Often, the suggested dose for these supplements exceeds estimated daily amino acid requirements. Few studies have tested whether consumption of a large dose of a single amino acid can promote muscle protein anabolism. This study demonstrates that oral administration of leucine stimulates synthesis of skeletal muscle proteins in food-deprived rats independently of changes in the circulating concentration of insulin. Complete recovery of muscle protein synthesis after leucine administration is associated with an increase in the availability of the mRNA cap-binding protein, eIF4E, for formation of the eIF4G·eIF4E complex. Further, leucine appears to regulate translation through activation of the p70S6k signaling pathway.

In a recent study, we reported that oral administration of leucine, alone or in combination with carbohydrate, immediately after treadmill exercise restores rates of protein synthesis to values equivalent to those of freely fed controls 1 h after meal provision (Anthony et al. 1999Citation ). Similarly, in this study, leucine stimulated muscle protein synthesis in rats that had been food deprived for 18 h. In both studies, serum insulin concentrations in rats fed leucine alone was not different from that of food-deprived controls. Collectively, these results suggest that the anabolic effect of leucine does not require an elevation in circulating insulin concentrations.

These results do not imply, however, that the protein synthetic response to leucine is independent of circulating insulin concentrations. Indeed, intraperitoneal administration of antibodies to insulin 3 h before and immediately after the start of refeeding into mice deprived of food overnight caused a partial attenuation in the stimulation of muscle protein synthesis (Svanberg et al. 1996Citation ). Furthermore, Preedy and Garlick (1986)Citation reported that intravenous administration of anti-insulin serum to food-deprived rats immediately before refeeding prevented a postprandial rise in muscle protein synthesis. Therefore, insulin availability may be essential to facilitate increases in protein synthesis after amino acid intake.

There are several potential mechanisms that may lead to leucine’s stimulation of protein synthesis. Both the number of ribosomes per cell and the translational efficiency per ribosome determine the rate of tissue protein synthesis. In growing rats, comparable in age and strain to those employed in this study, food deprivation for up to 3 d and subsequent refeeding did not alter RNA content in skeletal muscle (Nakano and Sidransky 1978Citation ). Because >80% of total muscle RNA is ribosomal, these results suggest that short-term alterations in nutritional status of the animal do not alter ribosome number. Rather, alterations in the rate of protein synthesis in skeletal muscle that occur with acute modulation of nutritional status parallel changes in translation initiation activity (Yoshizawa et al. 1995Citation ).

Formation of the ternary initiation complex is one rate-controlling step in the complex process of translation initiation. This step requires interaction between eIF2 and eIF2B. Few studies have examined the role of eIF2/eIF2B in modulating skeletal muscle protein synthesis after food deprivation or refeeding. Cox et al. (1988)Citation demonstrated that 48 h of starvation is without effect on eIF2B activity or on phosphorylation of eIF2{alpha} even though muscle protein synthesis is decreased. Additionally, Yoshizawa et al. (1997)Citation observed no change in activity of eIF2B or the proportion of eIF2{alpha} in the phosphorylated form when refeeding a macronutrient-mixed meal to rats that had been food deprived for18 h. Similarly, in this study, neither food deprivation nor meal administration altered the activity of eIF2B or the proportion of eIF2{alpha} in the phosphorylated form. These results suggest that the stimulatory effects of refeeding leucine on skeletal muscle protein synthesis in food-deprived rats must be through modulation of translational components other than those that are requisite for formation of the ternary initiation complex.

Another principal site of regulation in the initiation process involves the recognition and unwinding of the mRNA to allow binding to the 40S ribosome. This tightly regulated step requires the participation of eIF4B and eIF4F, a three-subunit complex consisting of eIF4A, eIF4E and eIF4G. There are currently two characterized mechanisms in which changes in eIF4F function alter translation initiation. The first mechanism involves modulation of eIF4E availability via the binding of eIF4E to the translational repressor, 4E-BP1. Studies in rats show that an increased proportion of eIF4E is bound to 4E-BP1 rather than eIF4G after overnight food deprivation (Yoshizawa et al. 1997Citation ). The changes in eIF4E availability occur in response to a decrease in 4E-BP1 phosphorylation. These results suggest that food deprivation decreases the availability of eIF4E to form an active eIF4G·eIF4E complex, and hence translation initiation. Refeeding starved animals a nutritionally complete diet elicits the opposite effect, i.e., hyperphosphorylation of 4E-BP1, freeing eIF4E from 4E-BP1 and increasing formation of eIF4G·eIF4E (Yoshizawa et al. 1997Citation and 1998Citation ). Therefore, refeeding is postulated to augment rates of protein synthesis by promoting increases in eIF4E availability. The results of this study demonstrate that the stimulatory effect of leucine on muscle protein synthesis is also associated with an increase in eIF4E availability. Oral administration of meals containing leucine stimulated the phosphorylation of 4E-BP1, reduced its association with eIF4E and resulted in a greater proportion of eIF4E free to interact with eIF4G. These results implicate leucine as a potential signaling molecule that promotes eIF4E availability after refeeding.

A second mechanism of altered eIF4F function involves modulation of eIF4E phosphorylation. Studies using cells in culture suggest that an increase in eIF4E phosphorylation enhances mRNA cap-binding affinity and/or association with eIF4G. These changes augment rates of protein synthesis and cell growth (Bu et al. 1993Citation , Minich et al. 1994Citation ). In contrast, experiments in vivo demonstrate that eIF4E phosphorylation either does not change or increases and then decreases during food deprivation and after refeeding, respectively (Yoshizawa et al. 1997Citation and 1998Citation ). In this study, administration of test diets containing leucine, but not carbohydrate alone, resulted in a net dephosphorylation of eIF4E compared with food-deprived rats. The basis for this reduction in phosphorylation is unknown. It has been proposed that the rate of phosphate turnover on eIF4E rather than the actual amount of eIF4E in the phosphorylated form is important for controlling protein synthesis (Rinker-Schaeffer et al. 1992Citation ). Supporting this notion, in insulin-treated cells in culture, the magnitude of the increase of 32Pi incorporation into eIF4E caused by insulin is much greater than the increase in the proportion of the protein in the phosphorylated form (Rinker-Schaeffer et al. 1992Citation , Rychlik et al. 1990Citation ).

The precise intracellular signaling pathway responsible for increasing rates of translation initiation in response to oral administration of leucine remains to be elucidated, but recent evidence suggests the involvement of p70S6k (Kimball et al. 1998, Patti et al. 1998Citation ). The p70S6k signaling pathway is implicated in stimulating skeletal muscle protein synthesis and increasing 4E-BP1 phosphorylation in response to refeeding (Svanberg et al. 1997Citation ). Further, in cultures of L6 myoblasts, addition of leucine to the medium of cells deprived of the amino acid increases protein synthesis and 4E-BP1 phosphorylation (Kimball et al. 1998bCitation ). Concomitant with these changes, leucine also increases phosphorylation of p70S6k. This study supports these observations because oral administration of leucine to food-deprived rats increased the degree of p70S6k phosphorylation, suggesting that the amino acid augments rates of protein synthesis through the activation of the p70S6k signaling pathway.

Although the p70S6k signaling pathway appears to be important in regulating rates of translation initiation, p70S6k does not appear to be the kinase responsible for phosphorylating 4E-BP1 directly because purified p70S6k does not phosphorylate recombinant 4E-BP1 directly (Haystead et al. 1994Citation ). In contrast, the kinase, mammalian target of rapamycin (mTOR), phosphorylates both 4E-BP1 and p70S6k in vitro (Burnett et al. 1998Citation ). Studies using L6 myoblasts in culture treated with the immunosuppressant drug, rapamycin, an inhibitor of mTOR, show that it blocks activation of p70S6k as well as phosphorylation of 4E-BP1 caused by leucine (Kimball et al. 1999Citation ). Whether oral administration of leucine activates mTOR directly or promotes phosphorylation of 4E-BP1 and p70S6k via another kinase(s) remains to be determined.


    ACKNOWLEDGMENTS
 
The authors thank and acknowledge the expert technical assistance of Lynne Hugendubler in the analysis of eIF2B activity and Tracie Gilpin for the determination of the specific radioactivity of serum phenylalanine. Further, we would like to thank Yuqun Hong and Margaret McNurlan (Department of Surgery, State University of New York at Stony Brook) for the analysis of serum leucine concentrations.


    FOOTNOTES
 
1 Presented in part at Experimental Biology 99, April 1999, Washington, DC [Anthony, J. C., Gautsch Anthony, T., Kimball, S. R. & Jefferson, L. S. (1999) Refeeding leucine stimulates translation initiation in skeletal muscle of postabsorptive rats. FASEB J. 13: A1025 (abs.)].

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2 Supported by research grants DK-15658 (L.S.J.), GM-39277 (T.C.V.) and a training grant, GM-08619, (supports J.C.A.) from the National Institutes of Health.

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3 J.C.A. received the 1999 ASNS/Procter and Gamble Company Graduate Student Research Award.

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5 Abbreviations used: CHO, food-deprived rats refed a 100% carbohydrate meal; CL, food-deprived rats refed a combination of carbohydrate plus leucine; 4E-BP1, eIF4E-binding protein 1; eIF, eukaryotic initiation factor; F, freely fed rats; L, food-deprived rats refed a 100% leucine meal; met-tRNAi, initiator methionyl-tRNA; mTOR, mammalian target of rapamycin kinase; p70S6k, 70-kDa ribosomal protein S6 kinase; S, food-deprived rats.

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Manuscript received June 8, 1999. Initial review completed July 14, 1999. Revision accepted October 19, 1999.


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 ABSTRACT
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 RESULTS
 DISCUSSION
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Am. J. Physiol. Endocrinol. Metab.Home page
J. Escobar, J. W. Frank, A. Suryawan, H. V. Nguyen, S. R. Kimball, L. S. Jefferson, and T. A. Davis
Physiological rise in plasma leucine stimulates muscle protein synthesis in neonatal pigs by enhancing translation initiation factor activation
Am J Physiol Endocrinol Metab, May 1, 2005; 288(5): E914 - E921.
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R. Koopman, A. J. M. Wagenmakers, R. J. F. Manders, A. H. G. Zorenc, J. M. G. Senden, M. Gorselink, H. A. Keizer, and L. J. C. van Loon
Combined ingestion of protein and free leucine with carbohydrate increases postexercise muscle protein synthesis in vivo in male subjects
Am J Physiol Endocrinol Metab, April 1, 2005; 288(4): E645 - E653.
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S. J. Crozier, S. R. Kimball, S. W. Emmert, J. C. Anthony, and L. S. Jefferson
Oral Leucine Administration Stimulates Protein Synthesis in Rat Skeletal Muscle
J. Nutr., March 1, 2005; 135(3): 376 - 382.
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Am. J. Physiol. Endocrinol. Metab.Home page
C. C. Carroll, J. D. Fluckey, R. H. Williams, D. H. Sullivan, and T. A. Trappe
Human soleus and vastus lateralis muscle protein metabolism with an amino acid infusion
Am J Physiol Endocrinol Metab, March 1, 2005; 288(3): E479 - E485.
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M. Prod'homme, M. Balage, E. Debras, M.-C. Farges, S. Kimball, L. Jefferson, and J. Grizard
Differential effects of insulin and dietary amino acids on muscle protein synthesis in adult and old rats
J. Physiol., February 15, 2005; 563(1): 235 - 248.
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Am. J. Physiol. Endocrinol. Metab.Home page
J. I. Baum, J. C. O'Connor, J. E. Seyler, T. G. Anthony, G. G. Freund, and D. K. Layman
Leucine reduces the duration of insulin-induced PI 3-kinase activity in rat skeletal muscle
Am J Physiol Endocrinol Metab, January 1, 2005; 288(1): E86 - E91.
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Am. J. Physiol. Heart Circ. Physiol.Home page
T. C. Vary, G. Deiter, and S. A. Goodman
Acute alcohol intoxication enhances myocardial eIF4G phosphorylation despite reducing mTOR signaling
Am J Physiol Heart Circ Physiol, January 1, 2005; 288(1): H121 - H128.
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Am. J. Physiol. Gastrointest. Liver Physiol.Home page
M. D. Sans, S.-H. Lee, L. G. D'Alecy, and J. A. Williams
Feeding activates protein synthesis in mouse pancreas at the translational level without increase in mRNA
Am J Physiol Gastrointest Liver Physiol, September 1, 2004; 287(3): G667 - G675.
[Abstract] [Full Text] [PDF]


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Am. J. Physiol. Endocrinol. Metab.Home page
Z. Liu, G. Li, S. R. Kimball, L. A. Jahn, and E. J. Barrett
Glucocorticoids modulate amino acid-induced translation initiation in human skeletal muscle
Am J Physiol Endocrinol Metab, August 1, 2004; 287(2): E275 - E281.
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J. Nutr.Home page
D. R. Bolster, T. C. Vary, S. R. Kimball, and L. S. Jefferson
Leucine Regulates Translation Initiation in Rat Skeletal Muscle Via Enhanced eIF4G Phosphorylation
J. Nutr., July 1, 2004; 134(7): 1704 - 1710.
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Am. J. Physiol. Gastrointest. Liver Physiol.Home page
M. Tashiro, L. C. Samuelson, R. A. Liddle, and J. A. Williams
Calcineurin mediates pancreatic growth in protease inhibitor-treated mice
Am J Physiol Gastrointest Liver Physiol, May 1, 2004; 286(5): G784 - G790.
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J ANIM SCIHome page
T. A. Davis, J. A. Bush, R. C. Vann, A. Suryawan, S. R. Kimball, and D. G. Burrin
Somatotropin regulation of protein metabolism in pigs
J Anim Sci, January 1, 2004; 82(13_suppl): E207 - 213.
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J. Nutr.Home page
L. S. Jefferson and S. R. Kimball
Amino Acids as Regulators of Gene Expression at the Level of mRNA Translation
J. Nutr., June 1, 2003; 133(6): 2046S - 2051.
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I. Rieu, C. Sornet, G. Bayle, J. Prugnaud, C. Pouyet, M. Balage, I. Papet, J. Grizard, and D. Dardevet
Leucine-Supplemented Meal Feeding for Ten Days Beneficially Affects Postprandial Muscle Protein Synthesis in Old Rats
J. Nutr., April 1, 2003; 133(4): 1198 - 1205.
[Abstract] [Full Text] [PDF]


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Am. J. Physiol. Endocrinol. Metab.Home page
H. Kobayashi, E. Borsheim, T. G. Anthony, D. L. Traber, J. Badalamenti, S. R. Kimball, L. S. Jefferson, and R. R. Wolfe
Reduced amino acid availability inhibits muscle protein synthesis and decreases activity of initiation factor eIF2B
Am J Physiol Endocrinol Metab, March 1, 2003; 284(3): E488 - E498.
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D. K. Layman
The Role of Leucine in Weight Loss Diets and Glucose Homeostasis
J. Nutr., January 1, 2003; 133(1): 261S - 267.
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J. Clin. Endocrinol. Metab.Home page
Z. Liu, L. A. Jahn, L. Wei, W. Long, and E. J. Barrett
Amino Acids Stimulate Translation Initiation and Protein Synthesis through an Akt-Independent Pathway in Human Skeletal Muscle
J. Clin. Endocrinol. Metab., December 1, 2002; 87(12): 5553 - 5558.
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Am. J. Physiol. Endocrinol. Metab.Home page
E. Borsheim, K. D. Tipton, S. E. Wolf, and R. R. Wolfe
Essential amino acids and muscle protein recovery from resistance exercise
Am J Physiol Endocrinol Metab, October 1, 2002; 283(4): E648 - E657.
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R. R. Wolfe
Regulation of Muscle Protein by Amino Acids
J. Nutr., October 1, 2002; 132(10): 3219S - 3224.
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J. Appl. Physiol.Home page
S. R. Kimball, P. A. Farrell, and L. S. Jefferson
Exercise Effects on Muscle Insulin Signaling and Action: Invited Review: Role of insulin in translational control of protein synthesis in skeletal muscle by amino acids or exercise
J Appl Physiol, September 1, 2002; 93(3): 1168 - 1180.
[Abstract] [Full Text] [PDF]


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Am. J. Physiol. Endocrinol. Metab.Home page
C. J. Lynch, B. J. Patson, J. Anthony, A. Vaval, L. S. Jefferson, and T. C. Vary
Leucine is a direct-acting nutrient signal that regulates protein synthesis in adipose tissue
Am J Physiol Endocrinol Metab, September 1, 2002; 283(3): E503 - E513.
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Am. J. Physiol. Endocrinol. Metab.Home page
W. Shen, D. Mallon, D. W. Boyle, and E. A. Liechty
IGF-I and insulin regulate eIF4F formation by different mechanisms in muscle and liver in the ovine fetus
Am J Physiol Endocrinol Metab, September 1, 2002; 283(3): E593 - E603.
[Abstract] [Full Text] [PDF]


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Am. J. Physiol. Endocrinol. Metab.Home page
J. C. Anthony, C. H. Lang, S. J. Crozier, T. G. Anthony, D. A. MacLean, S. R. Kimball, and L. S. Jefferson
Contribution of insulin to the translational control of protein synthesis in skeletal muscle by leucine
Am J Physiol Endocrinol Metab, May 1, 2002; 282(5): E1092 - E1101.
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S. R. Kimball
Regulation of Global and Specific mRNA Translation by Amino Acids
J. Nutr., May 1, 2002; 132(5): 883 - 886.
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DiabetesHome page
J. C. Anthony, A. K. Reiter, T. G. Anthony, S. J. Crozier, C. H. Lang, D. A. MacLean, S. R. Kimball, and L. S. Jefferson
Orally Administered Leucine Enhances Protein Synthesis in Skeletal Muscle of Diabetic Rats in the Absence of Increases in 4E-BP1 or S6K1 Phosphorylation
Diabetes, April 1, 2002; 51(4): 928 - 936.
[Abstract] [Full Text] [PDF]


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DiabetesHome page
Y. Boirie, K. R. Short, B. Ahlman, M. Charlton, and K. S. Nair
Tissue-Specific Regulation of Mitochondrial and Cytoplasmic Protein Synthesis Rates by Insulin
Diabetes, December 1, 2001; 50(12): 2652 - 2658.
[Abstract] [Full Text] [PDF]


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Am. J. Physiol. Endocrinol. Metab.Home page
T. C. Vary, L. S. Jefferson, and S. R. Kimball
Insulin fails to stimulate muscle protein synthesis in sepsis despite unimpaired signaling to 4E-BP1 and S6K1
Am J Physiol Endocrinol Metab, November 1, 2001; 281(5): E1045 - E1053.
[Abstract] [Full Text] [PDF]


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Am. J. Physiol. Endocrinol. Metab.Home page
T. G. Anthony, A. K. Reiter, J. C. Anthony, S. R. Kimball, and L. S. Jefferson
Deficiency of dietary EAA preferentially inhibits mRNA translation of ribosomal proteins in liver of meal-fed rats
Am J Physiol Endocrinol Metab, September 1, 2001; 281(3): E430 - E439.
[Abstract] [Full Text] [PDF]


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Am. J. Physiol. Endocrinol. Metab.Home page
J. S. Greiwe, G. Kwon, M. L. McDaniel, and C. F. Semenkovich
Leucine and insulin activate p70 S6 kinase through different pathways in human skeletal muscle
Am J Physiol Endocrinol Metab, September 1, 2001; 281(3): E466 - E471.
[Abstract] [Full Text] [PDF]


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Am. J. Physiol. Endocrinol. Metab.Home page
M. Balage, S. Sinaud, M. Prod'Homme, D. Dardevet, T. C. Vary, S. R. Kimball, L. S. Jefferson, and J. Grizard
Amino acids and insulin are both required to regulate assembly of the eIF4E {middle dot} eIF4G complex in rat skeletal muscle
Am J Physiol Endocrinol Metab, September 1, 2001; 281(3): E565 - E574.
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J. Nutr.Home page
L. S. Jefferson and S. R. Kimball
Amino Acid Regulation of Gene Expression
J. Nutr., September 1, 2001; 131(9): 2460S - 2466.
[Abstract] [Full Text] [PDF]


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Am. J. Physiol. Endocrinol. Metab.Home page
E. Blomstrand and B. Saltin
BCAA intake affects protein metabolism in muscle after but not during exercise in humans
Am J Physiol Endocrinol Metab, August 1, 2001; 281(2): E365 - E374.
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J. Clin. Endocrinol. Metab.Home page
Z. Liu, L. A. Jahn, W. Long, D. A. Fryburg, L. Wei, and E. J. Barrett
Branched Chain Amino Acids Activate Messenger Ribonucleic Acid Translation Regulatory Proteins in Human Skeletal Muscle, and Glucocorticoids Blunt This Action
J. Clin. Endocrinol. Metab., May 1, 2001; 86(5): 2136 - 2143.
[Abstract] [Full Text]


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J. Nutr.Home page
T. G. Anthony, J. C. Anthony, F. Yoshizawa, S. R. Kimball, and L. S. Jefferson
Oral Administration of Leucine Stimulates Ribosomal Protein mRNA Translation but Not Global Rates of Protein Synthesis in the Liver of Rats
J. Nutr., April 1, 2001; 131(4): 1171 - 1176.
[Abstract] [Full Text]


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J. Am. Soc. Nephrol.Home page
G. GARIBOTTO, A. SOFIA, A. CANEPA, S. SAFFIOTI, P. SACCO, M. R. SALA, L. DERTENOIS, N. PASTORINO, G. DEFERRARI, and R. RUSSO
Acute Effects of Peritoneal Dialysis with Dialysates Containing Dextrose or Dextrose and Amino Acids on Muscle Protein Turnover in Patients with Chronic Renal Failure
J. Am. Soc. Nephrol., March 1, 2001; 12(3): 557 - 567.
[Abstract] [Full Text]


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J. Nutr.Home page
S. M. Hutson and R. A. Harris
Introduction
J. Nutr., March 1, 2001; 131(3): 839S - 840.
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J. Nutr.Home page
R. A. Harris, R. Kobayashi, T. Murakami, and Y. Shimomura
Regulation of Branched-Chain {{alpha}}-Keto Acid Dehydrogenase Kinase Expression in Rat Liver
J. Nutr., March 1, 2001; 131(3): 841S - 845.
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J. Nutr.Home page
J. C. Anthony, T. G. Anthony, S. R. Kimball, and L. S. Jefferson
Signaling Pathways Involved in Translational Control of Protein Synthesis in Skeletal Muscle by Leucine
J. Nutr., March 1, 2001; 131(3): 856S - 860.
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J. Nutr.Home page
C. J. Lynch
Role of Leucine in the Regulation of mTOR by Amino Acids: Revelations from Structure-Activity Studies
J. Nutr., March 1, 2001; 131(3): 861S - 865.
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J. Clin. Endocrinol. Metab.Home page
E. Volpi, B. Mittendorfer, B. B. Rasmussen, and R. R. Wolfe
The Response of Muscle Protein Anabolism to Combined Hyperaminoacidemia and Glucose-Induced Hyperinsulinemia Is Impaired in the Elderly
J. Clin. Endocrinol. Metab., December 1, 2000; 85(12): 4481 - 4490.
[Abstract] [Full Text]


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Am. J. Physiol. Endocrinol. Metab.Home page
C. H. Lang, R. A. Frost, V. Kumar, and T. C. Vary
Impaired myocardial protein synthesis induced by acute alcohol intoxication is associated with changes in eIF4F
Am J Physiol Endocrinol Metab, November 1, 2000; 279(5): E1029 - E1038.
[Abstract] [Full Text] [PDF]


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Am. J. Physiol. Endocrinol. Metab.Home page
S. R. Kimball, L. S. Jefferson, H. V. Nguyen, A. Suryawan, J. A. Bush, and T. A. Davis
Feeding stimulates protein synthesis in muscle and liver of neonatal pigs through an mTOR-dependent process
Am J Physiol Endocrinol Metab, November 1, 2000; 279(5): E1080 - E1087.
[Abstract] [Full Text] [PDF]


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Am. J. Physiol. Endocrinol. Metab.Home page
O. J. Shah, J. C. Anthony, S. R. Kimball, and L. S. Jefferson
Glucocorticoids oppose translational control by leucine in skeletal muscle
Am J Physiol Endocrinol Metab, November 1, 2000; 279(5): E1185 - E1190.
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J. Nutr.Home page
D. Dardevet, C. Sornet, M. Balage, and J. Grizard
Stimulation of In Vitro Rat Muscle Protein Synthesis by Leucine Decreases with Age
J. Nutr., November 1, 2000; 130(11): 2630 - 2635.
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Am. J. Physiol. Endocrinol. Metab.Home page
O. J. Shah, J. C. Anthony, S. R. Kimball, and L. S. Jefferson
4E-BP1 and S6K1: translational integration sites for nutritional and hormonal information in muscle
Am J Physiol Endocrinol Metab, October 1, 2000; 279(4): E715 - E729.
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J. Nutr.Home page
J. C. Anthony, F. Yoshizawa, T. G. Anthony, T. C. Vary, L. S. Jefferson, and S. R. Kimball
Leucine Stimulates Translation Initiation in Skeletal Muscle of Postabsorptive Rats via a Rapamycin-Sensitive Pathway
J. Nutr., October 1, 2000; 130(10): 2413 - 2419.
[Abstract] [Full Text]


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J. Nutr.Home page
L. J. C. van Loon, M. Kruijshoop, H. Verhagen, W. H. M. Saris, and A. J. M. Wagenmakers
Ingestion of Protein Hydrolysate and Amino Acid-Carbohydrate Mixtures Increases Postexercise Plasma Insulin Responses in Men
J. Nutr., October 1, 2000; 130(10): 2508 - 2513.
[Abstract] [Full Text]


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Am. J. Physiol. Endocrinol. Metab.Home page
S. R. Kimball, P. A. Farrell, H. V. Nguyen, L. S. Jefferson, and T. A. Davis
Developmental decline in components of signal transduction pathways regulating protein synthesis in pig muscle
Am J Physiol Endocrinol Metab, March 1, 2002; 282(3): E585 - E592.
[Abstract] [Full Text] [PDF]


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